Medical Patients

Patient Name*
Guarantor's Name
Guarantor's Address
Street Address (required) Address Line 2 City (required) State (required) ZIP Code (required)
Policy Holder's Name*
Policy Holder's Address*
Street Address (required) Address Line 2 City (required) State (required) ZIP Code (required)
Insurance Company*
Insurance Company's Address*
Street Address (required) Address Line 2 City (required) State (required) ZIP Code (required)
Employee Name*
Employee's Address*
Street Address (required) Address Line 2 City (required) State (required) ZIP Code (required)
Policy Number*
Group Number*
Email Address*
I Agree To Communication Via Email*
- I agree
Name
This field is for validation purposes and should be left unchanged.

California residents:

The state rosenthal fair debt collection practices act and the federal fair debt collection practices act require that, except under unusual circumstances, collector may not contact you before 8 a.m. or after 9 p.m. they may not harass you by using threats of violence or arrest or by using obscene language. Collectors may not use false or misleading statements or call you at work if they know or have reason to know that you may not receive personal calls at work. For the most part, collectors may not tell another person, other than your attorney or spouse about your debt. Collectors may contact another person to confirm your location or enforce a judgment. For more information about debt collection activities, you may contact the federal trade commission at 1-877-ftc-help or www.ftc.gov

California and Utah residents:

As required by law, you are hereby notified that a negative credit report reflecting on your credit record may be submitted to a credit reporting agency if you fail to fulfill the terms of your credit obligations. But we will not submit a negative credit report to a credit reporting agency about this credit obligation until the expiration of the time period described in the first notice you received from us.

Colorado residents:

For information about the Colorado fair debt collection practices act, see www.ago.state.co.us/cadc/cadcmain.cfm

Massachusetts residents:

Massachusetts residents may contact our office by telephone at the number, office hours and address stated on the bottom of this page or to 101 federal street, boston ma 02110.

Notice of important rights

You have th right to make a written or oral request that telephone calls regarding your debt not be made to you at your place of employment. Any such oral request will be valid for only ten days unless you provide written confirmation of the request postmarked or delivered within seven days of such request. You may terminate this request by writing to the collection agency.

Minnesota residents:

This collection agency is licensed by the Minnesota department of commerce.

Nevada hospital patients only:

(a) if the debtor pays or agrees to pay the debt or any portion of the debt, the payment or agreement to pay may be construed as: (1) an acknowledgement of the debt by the debtor; and (2) a waiver by the debtor or any applicable statute of limitations set forth in nrs 11.190 that otherwise precludes the collection of the debt; and (b) if the debtor does not understand or has questions concerning this legal rights or obligations relating to the debt, the debtor should seek legal advice.

New york city residents:

New york city department of consumer affairs license number: 1239906

North carolina residents:

NC permit no. 4485

NRA group, llc dba national recovery agency, general information:

Physical Address
2491 Paxton Street
Harrisburg, PA 17111

Hours of Operation
Monday-Thursday: 8:00 AM – 8:30 PM EST
Friday: 8:00 AM – 5:00 PM EST
Saturday: 8:00 AM – 12:30 PM EST
Sunday: Closed

Pay in Person

Pay By Phone

Pay By UPS/FedEx

Pay By Mail

Pay By HSA